proprioceptive neuromuscular facilitation
TRANSCRIPT
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PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION
Aarti SareenMSPT (honours )
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includes
• PNF definition• Neurophysiologic basis of PNF• Uses of PNF• 9 basic principles of PNF• Techniques of PNF• PNF stretching• Patterns of PNF
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DEFINITION
• Proprioceptive: having to do with any of the sensory receptors that give information concerning movement and position of the body
• Neuromuscular: involving the nerves and muscles
• Facilitation: making easier
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• Proprioceptive neuromuscular facilitation is exercise based on the principles of functional human anatomy and neurophysiology.
• It uses– Proprioceptive– Cutaneous– Auditory inputTo produce functional improvement in motor output
and can be a vital element in the rehabilitation process of sports related injuries.
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NEUROPHYSIOLOGICAL BASIS OF PNF
• Sherrington..– Concepts of facilitation and inhibition– Stretch reflex– Neurophysiological phenomena
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FACILITATION
• Facilitory - an impulse causing the recruitment and discharge of additional motor neurons in the spinal cord– Results in increased
excitability in the muscles.– Weak muscles would be
aided through facilitation
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INHIBITION
• Inhibitory - any stimulus that causes motor neurons to drop away from the discharge zone and away from the spinal cord.– Inhibition results in
decreased excitability of motor neurons.
– Muscle spasticity can be decreased
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STRETCH REFLEX
• The stretch reflex involves two types of receptors
Muscle spindlesGolgi tendon organs
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NEUROPHYSIOLOGICAL PHENOMENA
• RECIPROCAL INHIBITION• AUTOGENIC INHIBITION is defined as inhibition
mediated by afferent fibers from stretched muscle acting on the alpha motor neurons supplying that muscle, causing it to reflex
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Reciprocal inhibition
• Is the second mechanism which deals with the relationships of the agonist and antagonist muscles
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USES OF PNF• 1. PNF treatment has been used to increase
strength, flexibility, coordination and functional mobility.
• 2. The main goal of treatment is to facilitate the patient in achieving a movement or posture.
• 3. Stretches as well as diagonals and rational exercise patterns are used to improve ADL’s functional mobility and athletic performance
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• 4. It is mainly used in orthopedic rehabilitation for musculoskeletal injuries and in neurological rehab.
• 5. PNF can be used for any condition, however the patient condition level may require modifications.
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BASIC PRINCIPLES OF PNF
1. Resistance2. Irradiation and reinforcement3. Manual contact4. Stretch5. Verbal commands6. Traction and approximation7. Timing8. Body positioning and body mechanics
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1. RESISTANCE
Opposing force to the patient’s movement is called resistance.
The amount of resistance provided during an activity must be
correct for the patient’s condition and the goal of the activity. This is called optimal
resistance.
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1. RESISTANCE
Resistance is used in the treatment to:1. Facilitate the ability of the muscle to contract2. Increase motor control3. Help the patient gain an awareness of motion
and its direction4. Increase strength
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IRRADIATION & REINFORCEMENT
DEFINITIONS
• Irradiation : the spread of response to stimulation is called irradiation.
• Reinforcement : means “to strengthen by fresh addition, make stronger”
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IRRADIATION & REINFORCEMENT
Effects :• Maximal resistance may be used to cause
irradiation or overflow from stronger patterns to weaker patterns or from stronger groups of muscles within a pattern to weaker groups within the same pattern.
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MANUAL CONTACT
Effects: 1. Stimulates the muscle2. Stimulates the synergistic muscle to reinforce
the movement3. Promotes trunk stabilization and indirectly
helps the limb motion4. Prevents confusion
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Touch or manual contact
Contributes to facilitation by stimulating the exteroceptors and it should be
1. Purposeful2. Directional3. comfortable
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STRETCH
• The stretch stimulus occurs when the muscle is elongated
• The lengthened position of the muscle is the starting position of each pattern and the stretch is maintained throughout the movement.
• All the components of a pattern must be stretched simultaneously
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STRETCH
Effects:1. Stimulates the activity of muscle spindle2. Any contraction of muscle on stretch will
result in movement and the brain knows not of muscles but of movement.
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Alpha Motor Neuron
Quick Stretch
+
Muscle Spindle
++
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TRACTION
• Traction is elongation of trunk or an extremity
• Traction force is applied gradually, maintained throughout the movement, and combined with appropriate resistance.
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TRACTION
• Joint separation stimulates joint receptors• Muscle stretch stimulates muscle spindle
stretch receptor• Facilitates Alpha Motor Neuron• Facilitates Strength
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APPROXIMATION
• Definition: Approximation is the
compression of the trunk or an extremity.
• Compression through a joint stimulate joint receptors
• Facilitate alpha motor neuron• Facilitate stability
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APPROXIMATION
Uses:1. Promote stabilization2. Facilitate weight bearing and contraction of
postural muscles3. Facilitate upright reactions4. Resist some component of motion. E.g., use
approximation at the end of shoulder flexion to resist scapula elevation
(11)
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VERBAL STIMULATION (COMMANDS)
• The volume with which the command is given affects the strength of resulting muscle contraction.
• Louder command when strong muscle contraction is required.
Softer and calmer tone when the goal is relaxation and relief of pain.
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VERBAL STIMULATION (COMMANDS)
• The command is divided into three parts:1. Preparation: readies the pt for action.
“ready”2. Action: tells the pt to start the action. “now
pull your leg up and in”3. Correction: tells the pt how to correct and
modify the action. “keep pulling your toes up”
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Commmads used
• HOLD• PULL/PUSH• RELAX
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TIMINGS
• Timing is the sequencing of motions
• Normal timing of most coordinated and efficient motions is from distal to proximal
• Timing for emphasis involves changing the normal sequencing of motion to emphasis a particular muscle or desired activity
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BODY POSTION & BODY MECHANICS
• The therapist body should be in line of motion
• Shoulder and pelvis face the direction of motion.
• Therapist stands in walk standing position.
• The resistance comes from the therapist’s body, while the hands and arms stay comparatively relaxed.
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TECHNIQUES OF PNF
• Rhythmic initiation• Repeated contraction• Slow reversal• Slow reversal-hold• Rhythmic stabilization
Strengthening techniques
• Contract relax• Hold relax
Stretching techniques
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RHYTHMIC INITIATION• Progression from( agonist pattern)
USED IN• Limited ROM due to increase tone• Who are unable to initiate movement
PASSIVE
ACTIVE ASSISTED
ACTIVE
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REPEATED CONTRATION
• Patient move isotonically against maximum resistance repeatedly until fatigue is evidenced
• When fatigue is evident then a stretch at that point in the range should facilitate the weaker muscles and results in coordinated movement.
• USED • To develop strength and endurance.
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SLOW REVERSAL
• Involves isotonic contraction of the agonist followed immediately by an isotonic contraction of the antagonist.
• USED 1. For development of active ROM and2. Normal reciprocal timing b/w agonist and
antagonist
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SLOW REVERSAL HOLD
• Involves isotonic contraction of the agonist followed immediately by an isometric contraction, with a hold command given at the end of each active movement.
• USED • In developing strength at a specific point in the
range of motion.
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RHYTHMIC STABILIZATION
• Uses an isometric contraction of the agonist, followed by an isometric contraction of the antagonist.
• USED • To increase strength and endurance
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STRETCHING TECHNIQUES/PNF STRETCHING
• It is often a combination of passive stretching and isometrics contractions.
• encourage flexibility and coordination throughout the limb's entire
range of motion.
• PNF is used to supplement daily stretching and is employed to make quick gains in range of motion to help athletes improve performance.
• Good range of motion makes better biomechanics, reduces fatigue and helps prevent overuse injuries.
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CONTRACT-RELAX
• Moves the body part passively into the agonist pattern.
• Patient is instructed to push by contracting the antagonist isotonically against the resistance.
• USED• When ROM is limited by muscle tightness.
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HOLD RELAX
• Begins with isometric contraction of the antagonist against resistance, followed by concentric contraction of the agonist muscle.
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PNF STRETCHING
The initial movement is in the direction of the stretch
Next the athlete pushes in a direction against the stretch
The last movement is a repeat of the initial
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PNF PATTERNS
• Each pattern has three dimension – 1. Flexion or extension 2. Abduction or adduction3. Rotation • Movement occurs in a straight line, in
diagonal direction with a rotatory component
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UPPER EXTREMITY
F-ABD-ER F-ADD-ER
E-ABD-IR E-ADD-IR
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PATTERNS
SHOULDER
D1 FlexionShoulder FLEX, ADD, ER
Forearm - Sup
Wrist - Rad. Flexion
Fingers - flexion
D2 FlexionShoulder FLEX, ABD, ER
Forearm - Sup
Wrist - Rad. Flexion
Fingers - Extension
D1 ExtensionShoulder EXT, ABD, IR
Forearm - Pro
Wrist - Ulnar. extension
Fingers - Extension
D2 ExtensionShoulder EXT, ADD, IR
Forearm - Pro
Wrist - Ulnar ext.
Fingers - flexion
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Diagonal One Diagonal Two
F-ABD-ER E-ADD-IRF-ADD-ER E-ABD-IR
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LOWER EXTREMITY
F-ABD-IR F-ADD-ER
E-ABD-IR E-ADD-ER
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LOWER EXTREMITY
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LOWER TRUNK
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UPPER TRUNK
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PNF IN SPORTS
• Here are some other general guidelines when completing PNF stretching:
• 1. Leave 48 hours between PNF stretching routines.• 2. Perform only one exercise per muscle group in a session.• 3. For each muscle group complete 2-5 sets of the chosen exercise.• 4. Each set should consist of one stretch held for up to 30 seconds
after the contracting phase.• 5. PNF stretching is not recommended for anyone under the age of
18.• 6. If PNF stretching is to be performed as a separate exercise
session, a thorough warm up consisting of 5-10 minutes of light aerobic exercise and some dynamic stretches must precede it.
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• JOURNEL OF ATHLETIC TRAINING
• PNF techniques are most frequently applied during rehabilitation of the knee, shoulder, and hip, ankle rehabilitation has increased.
• The most frequently used techniques were contract-relax and hold-relax
• The use of PNF techniques in the muscle re-education phase of rehabilitation
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